Many states don’t want to participate in the new “high-risk” insurance pools for people with pre-existing medical conditions. Are consumers in those states barred from joining these pools?
More than a dozen states, citing cost concerns, have said they would not operate these federally subsidized programs for uninsured people who have been denied health insurance. “It is creating an unfunded mandate on the states,” says Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation. But in those non-participating states, the federal government will step in to run the pools for residents until 2014, when insurers will be barred from discriminating against people with pre-existing conditions. The temporary state pools are expected to begin July 1 and will receive a total of $5 billion in funding, which many experts feel is inadequate to cover their long-range costs.
Attorneys general in several states have filed lawsuits against the law. Can those legal actions block reform?
The state lawsuits challenge the law’s requirement for individuals to buy health insurance. Moffit of the Heritage Foundation calls that requirement an unprecedented expansion of congressional power. Yet many legal experts think that the states’ suits have little chance of success. “A state cannot sue the federal government to have a federal law invalidated,” says Timothy Jost, a professor at Washington and Lee University School of Law. Individuals’ lawsuits over paying a penalty could get more traction. But Jost says that Congress “can do anything it wants as long as it’s regulating economic activity. This is clearly economic activity.” Mark Hall of Wake Forest University School of Law says, “There’s not a constitutional right to be uninsured. ... It’s hard to argue that Congress can’t regulate it in this way.”
Can reform be repealed if Republicans gain control of both houses of Congress?
It’s an uphill climb for reform opponents. First, they must seize control of both houses. Then, if the president vetoes a repeal bill - and President Obama assuredly will -- Republicans must command a two-thirds congressional majority to override the veto. But if a Republican wins the presidency in 2012 or in 2016, repeal of health reform becomes more possible. Under that scenario, they would need a filibuster-proof 60 votes to junk the law entirely. But short of 60, Republicans with a Senate majority could still cut off or delay funding for implementation of reform provisions. Reform opponents with a majority “can always make trouble for the president,” Jost says.